Resuscitation for Cardiac and Respiratory Arrest (CPR)
Cardiac arrest is an absolute emergency. The animal is lying down and unresponsive. Without immediate help, the animal faces death within approximately 5–8 minutes. Resuscitation measures (CPR) must be initiated immediately.
Resuscitation (cardiopulmonary resuscitation, CPR) in the context of first aid refers to ventilation and chest compressions performed by a person on a patient (dog, cat, human) who no longer has their own breathing and heart function.
Knowledge of resuscitation can be life-saving for your pet.
It is performed according to the so-called ABC method. This method is used when no aids or medications are available.
Under clinical conditions, other measures are, of course, taken.
A stands for Airway
B stands for Breathing
C stands for Cardiac Resuscitation.
A structured approach following this ABC scheme should be practiced. You can mentally review it multiple times at home, practice subtly (!) on your pet, or ideally, train on a dummy in a first aid course.
First Aid
Before you begin, check if the animal is responsive. If so, no resuscitation is necessary. In cases of convulsive breathing, known as agonal breathing, immediately begin chest compressions.
A Airway Control
- Place the dog on its right side so that the heart, which is located more to the left in the chest, can be accessed more easily.
- Opening the oral cavity
- Check the oral cavity for visible foreign bodies (vomit?) that may obstruct the airways.
- Gently pull the tongue out and to the side.
- Extend the head
- First, apply a single, short, strong pressure to the chest to simulate an exhalation burst and thus re-check whether vomit or other foreign bodies are obstructing the airways and need to be removed.
B Breathing
Breathing is checked by observing chest movements or by checking exhalation by holding the back of a hand in front of the nostrils. If no breathing is detected, begin ventilation.
- The tongue is moved back into the oral cavity and the mouth is closed.
- Cup the animal’s mouth and gently bend the animal’s head backward before starting ventilation.
- If possible, also pull the lower jaw slightly forward.
- If you do not bend your pet’s head backward, the air blown in might go into the stomach instead of the lungs.
- Keep the animal’s mouth closed.
- Place a clean cloth over the nostrils and blow so that the chest only rises slightly.
- Firmly cup the animal’s muzzle with one hand and perform mouth-to-nose ventilation with initially 1–2 breaths per minute.
- A total of 20 breaths per minute should be given for large dogs and 24 breaths per minute for small dogs or cats.
- Allow time for exhalation between each breath.
Keep in mind that your tidal volume is most likely significantly larger than your pet’s. Therefore, you must not blow a full, strong breath into your pet. This would overstretch the animal’s lung elasticity and burst the alveoli. The chest should only rise slightly. If it does not rise, you must bend the head back a little further and try ventilation again. For very small animals, it may be sufficient to slowly transfer only the air volume from your mouth into the animal using the force of your cheeks. Here, too, the chest should rise slightly.
If your animal performs normal movements, interrupt emergency measures and observe it. Seizures are not normal movements.
C Cardiac Resuscitation for Cardiac Arrest
Cardiac resuscitation refers to all measures aimed at ending cardiorespiratory arrest. Initially, a single “precordial” thump is performed (a term from human medicine, precordial means “in front of the heart”). In dogs, this is done on the dog lying on its right side, laterally in line with the elbow joint. For small dogs and cats in right lateral recumbency, a short impulse can also be given in the same region. Of course, not a fist thump in the literal sense. If no heartbeat is palpable afterward, chest compressions should be started at the highest point of the chest behind the elbow. For cardiac massage in cardiac arrest, press with extended arms on the highest point of the chest behind the left elbow approximately 60–80 times per minute.
Chest Compression
- Place your pet on a smooth, firm surface on its right side, not on its back as with humans.
- Kneel in front of your pet on its belly side.
- Place the palm of your hand in the region behind the left elbow. You can support the pressure with your other palm. Keep your arms straight.
- For very large dogs, you can extend the chest compression to three to four centimeters. You may also use the weight of your upper body to achieve the compression. 60–80 chest compressions/min are performed.
- For small dogs and cats, use only one hand or even just your fingers for compression. Cup the sternum from below and perform compressions in the elbow region on both sides between your thumb and the other four fingers. A frequency of 120 to 140 compressions/min should be aimed for.
- Try to achieve a steady rhythm between ventilation and chest compression. After two ventilations, perform 15 chest compressions, then ventilate twice again, and so on.
- In between, check whether the measures were successful and if a heartbeat or pulse is palpable.
Learn these measures in a relevant course before an emergency occurs, if possible.
It is often better to do something than nothing, even if you are unsure. If you are inexperienced, limit yourself to lateral chest compressions in rapid succession (one to two times per second!). This ensures blood flow and thus oxygen transport to the brain, heart, and other vital organs.
Be careful to consider the small size of your pet when applying force. The chest should be gently compressed, but the ribs should not be injured.
Seek veterinary attention as quickly as possible. Continue resuscitation measures, if possible, until you hand your pet over to a veterinarian.
Fig.: Marking the heart’s position in cats. For chest compressions with one hand, cup the chest from below and apply rhythmic pressure with only 2 or 3 fingers.